# FOUR HOLES INDIAN ORGANIZATION EDISTO TRIBAL INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Edisto Indian Free Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407250566
- **Authorized official:** DONNIE CREEL (CHAIRMAN OF THE BOARD)
- **Authorized official phone:** (843) 871-2126

## Contact information

- **Practice address:** 1125 RIDGE RD, RIDGEVILLE, SC 29472-7846
- **Practice address phone:** (843) 871-2126
- **Practice address fax:** (843) 832-6019
- **Mailing address:** 1125 RIDGE RD, RIDGEVILLE, SC 29472-7846
- **Mailing address phone:** (843) 871-2126
- **Mailing address fax:** (843) 832-6019

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | SC | Yes |

## Other

- **Enumeration date:** 10/20/2014
- **Last updated:** 07/21/2022